Complications Related to Intravascular Treatment of Cerebral Arteriovenous Malformations

Kwon, Yang

Abstract

Endovascular embolization as sole therapy is curative only in a small percentage of cases, but is recommended as part of a multimodal approach to reduce the size of a large AVM, and decrease bleeding risk of lesions with multiple or inaccessible feeding vessels or associated aneurysms prior to surgery or radiotherapy. The result of endovascular treatment of a brain AVM in terms of the degree of obliteration achieved and complication rate depends mainly on the endovascular strategy developed and the technique applied. These depend on the specific angioarchitecture and topography of the individual AVM, on the past history and clinical presentation of the patient and on the predefined goal of embolization. The strategy should include the definition of embolization targets, the selection of the most appropriate approach for endovascular navigation, the determination of the sequence of catheterization of individual feeding arteries, the selection of the type of catheters and microcatheters, the selection of the appropriate embolic materials as well as the site and mode of their delivery.